scholarly journals Deterioration After Mild Traumatic Brain Injury: A Single-Center Experience With Cost Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Rafał Chojak ◽  
Marta Koźba-Gosztyła ◽  
Mateusz Pawłowski ◽  
Bogdan Czapiga
Keyword(s):  
Prognostic Model ◽  
Brain Injuries ◽  
Hospital Admissions ◽  
Good Condition ◽  
Neurosurgical Department ◽  
Total Cost ◽  
Single Center Experience ◽  
Number Of Patients ◽  
Gcs Score ◽  
Neurosurgical Intervention

Background: Most traumatic brain injuries (TBIs) are mild (GCS score of 13–15). Patients with mild TBI (mTBI) are generally in good condition. In some cases, a neurological deterioration (manifested by a drop of ≥1 point in GCS score) can occur and neurosurgical intervention (NI) may be needed. Because of that, these patients are frequently admitted to a hospital for observation. The aim of our study was to determine the number of patients with mTBI that deteriorate or need NI. We also considered an economic aspect of hospital admissions of these patients.Methods: The study group consisted of 186 adult patients admitted to the neurosurgical department due to mTBI. Patients were divided into three groups according to an initial GCS score. The occurrence of deterioration, need for NI, length of stay (LOS), cost of stay and occurrence of death were analyzed.Results: The deterioration was observed in 7 (3.76%) out of all cases. In 3 (1.61%) of them, the NI was needed. The average LOS was 7.96 days and it was closely linked with an initial GCS score (p < 0.001). The total cost of stay of all patients included in this study was about 1,188,668 PLN (306,357 USD).Conclusion: The deterioration occurred in a small number of patients with mTBI, the need for NI was even less common. Hospitalization of these patients is expensive. Further studies with prognostic model helping decide on admission/discharge are necessary.

scholarly journals Prothrombin Complex Concentrate for Warfarin-Associated Intracranial Bleeding in Neurosurgical Patients: A Single-Center Experience

Medicina ◽  
2018 ◽  
Vol 54 (2) ◽  
pp. 22 ◽  
Author(s):  
Jomantė Mačiukaitienė ◽  
Diana Bilskienė ◽  
Arimantas Tamašauskas ◽  
Adomas Bunevičius
Keyword(s):  
Prothrombin Complex Concentrate ◽  
International Normalized Ratio ◽  
Intracranial Bleeding ◽  
Neurosurgical Procedures ◽  
Single Center Experience ◽  
Number Of Patients ◽  
Neurosurgical Patients ◽  
Gcs Score ◽  
Emergent Surgery ◽  
Neurosurgical Intervention

Objective: The number of patients presenting with warfarin-associated intracranial bleeding and needing neurosurgical intervention is growing. Prothrombin complex concentrate (PCC) is commonly used for anti-coagulation reversal before emergent surgery. We present our experience with PCC use in patients presenting with coagulopathy and needing urgent craniotomy. Methods: We retrospectively identified all patients presenting with intracranial bleeding and coagulopathy due to warfarin use, requiring urgent neurosurgical procedures, from January, 2014 (implementation of 4-PCC therapy) until December, 2016. For coagulation reversal, all patients received 4-PCC (Octaplex) and vitamin K. Results: Thirty-five consecutive patients (17 men; median age 72 years) were administered 4-PCC before emergent neurosurgical procedures. The majority of patients presented with traumatic subdural hematoma (62%) and spontaneous intracerebral hemorrhage (32%). All patients were taking warfarin. Median international normalized ratio (INR) on admission was 2.94 (range: 1.20 to 8.60). Median 4-PCC dose was 2000 I.U. (range: 500 I.U. to 3000 I.U.). There was a statically significant decrease in INR (p < 0.01), PT (p < 0.01), and PTT (p = 0.02) after 4-PCC administration. Postoperative INR values were ≤3.00 in all patients, and seven (20%) patients had normal INR values. There were no 4-PCC related complications. Four (11%) patients developed subdural/epidural hematoma and 20 (57%) patients died. Mortality was associated with lower Glasgow coma scale (GCS) score. Conclusions: The 4-PCC facilitates INR reversal and surgery in patients presenting with warfarin-associated coagulopathy and intracranial bleeding requiring urgent neurosurgical intervention.

scholarly journals The Effect of the COVID Pandemic Lockdown Measures on Surgical Emergencies: Experience and Lessons Learned from A Greek Tertiary Hospital.

2021 ◽  
Author(s):  
Emmanouil Pikoulis ◽  
Nikolaos Koliakos ◽  
Dimitrios Papaconstantinou ◽  
Nikolaos Pararas ◽  
Andreas Pikoulis ◽  
...  
Keyword(s):  
Brain Injuries ◽  
Hospital Admissions ◽  
Motor Vehicle ◽  
Admission Rate ◽  
Lessons Learned ◽  
University Hospital ◽  
Long Term Effects ◽  
Hospital Admission Rate ◽  
Surgical Department ◽  
Number Of Patients

Abstract Background: The COVID-19 pandemic caused a rise in healthcare demands and has necessitated a significant restructuring of hospital Emergency Departments.The present study aims to determine the pandemic lockdown's impact on the number of patients seeking assessment in the Surgical Emergency Department (SED) with General Surgery emergencies. Methods: Since the start of the Covid pandemic in Greece (1 March, 2020) and up to 15 December 2020, the charts of all patients arriving at the SED of the third surgical department of the “Attikon” University Hospital (a tertiary referral center for surgical and COVID-19 cases) were retrospectively reviewed and broken down in four periods reflecting two nationwide lockdown (period A; 1/3/2020 to 30/4/2020 and period D; 16/10/2020 to 15/12/2020) and two interim (period B; 1/5/2020 to 15/6/2020 and period C; 15/9/2020 to 30/10/2020) periods. Demographic and clinical data were compared to those obtained from the same time periods of the year 2019.Results:The total number of patients attending the SED decreased by 35.9% during the pandemic (from 2839 total patients in 2020 to 1819 in 2019). During the first lockdown, there was a statistically significant reduction of motor vehicle accidents (p=0.04) and torso injuries (p=0.01). A rise in the rate of traumatic brain injuries (p<0.001), abdominal pain (p=0.04) and hospital admissions (p=0.002) was also evident. During the second lockdown, there was a reduction in the number of perianal abscess cases (p=0.04) and hernia-related problems (p=0.001). An increase in the rate of fall injuries was also demonstrable (p=0.02).Conclusion: The burden of the new COVID-19 disease has left a noticeable imprint in the function of emergency departments worldwide. In Greece, implemented lockdown measures significantly impacted the SED attendance rates, the clinical characteristics of the attending patients and the overall hospital admission rate. The long-term effects on national health systems remain to be seen.

scholarly journals (P2-100) Prognosis of Unknown and Unattended Patients in the Neurosurgical Department

2011 ◽  
Vol 26 (S1) ◽  
pp. s169-s169
Author(s):  
A.S. Mathew
Keyword(s):  
Hospital Stay ◽  
Nursing Care ◽  
Road Traffic ◽  
Road Traffic Crash ◽  
Neurosurgical Department ◽  
Unique Problem ◽  
Average Hospital ◽  
Number Of Patients ◽  
The Mean ◽  
Gcs Score

BackgroundIn 2009 in Delhi, 7,516 road traffic crash victims were admitted to hospitals as unknown or unattended.ObjectiveThe aim of this study was to assess the morbidity and mortality of unknown or unattended patients and problems they faced relative to the provision of nursing care.MethodsThis is a retrospective analysis from February 2010 to August 2010 wherein all unknown or unattended patients with head injuries (Glasgow Coma Scale (GCS) score = 1–15) admitted to the neurosurgery department were included. The duration of hospital stay, admission GCS, and outcome were assessed and an attempt also was made to analyze the problems faced by nursing personnel.ObservationsThe total number of patients enrolled was 38. Of these, 22 were unknown, and 16 were unattended. The average hospital stay of unknown and unattended victims was 35 (1–151), and 21 (7–120) days, respectively. The mean GCS score of unknown patients upon admission was 9 (3–15), and during discharge, 8 (3–15). The mean GCS scores of unattended patients during admission and discharge was 12 (13–15) and 14 (3–15). respectively. Of the 22 unknown patients, 24% were identified during their stay, 33% were transferred to rehabilitation homes, and 43% died without being identified. Of the 16 unattended patients, 25% went home, 63% were transferred to rehabilitation homes, and 12% expired. The most common problems faced during nursing care were contractures (8%) and pressure sores (11%), due mainly to their long hospital stays.ConclusionsPatients remaining unknown/unattended is a unique problem as far as developing countries are concerned. Managing these patients is difficult, as they occupy hospital beds for a longer duration, and require more nursing care, and have higher mortality and morbidity. It remains surprising that in spite of advancements in the field of mass communication, almost 76% of the unknown patients remain unidentified.

scholarly journals Biomarkers-based personalized follow-up in chronic heart failure improves patient’s outcomes and reduces care associate cost

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Antonio Leon-Justel ◽  
Jose I. Morgado Garcia-Polavieja ◽  
Ana Isabel Alvarez-Rios ◽  
Francisco Jose Caro Fernandez ◽  
Pedro Agustin Pajaro Merino ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Admissions ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Secondary Outcome ◽  
Ventricular Ejection Fraction ◽  
Number Of Patients ◽  
Ed Visits ◽  
The Impact

Abstract Background Heart failure (HF) is a major and growing medical and economic problem, with high prevalence and incidence rates worldwide. Cardiac Biomarker is emerging as a novel tool for improving management of patients with HF with a reduced left ventricular ejection fraction (HFrEF). Methods This is a before and after interventional study, that assesses the impact of a personalized follow-up procedure for HF on patient’s outcomes and care associated cost, based on a clinical model of risk stratification and personalized management according to that risk. A total of 192 patients were enrolled and studied before the intervention and again after the intervention. The primary objective was the rate of readmissions, due to a HF. Secondary outcome compared the rate of ED visits and quality of life improvement assessed by the number of patients who had reduced NYHA score. A cost-analysis was also performed on these data. Results Admission rates significantly decreased by 19.8% after the intervention (from 30.2 to 10.4), the total hospital admissions were reduced by 32 (from 78 to 46) and the total length of stay was reduced by 7 days (from 15 to 9 days). The rate of ED visits was reduced by 44% (from 64 to 20). Thirty-one percent of patients had an improved functional class score after the intervention, whereas only 7.8% got worse. The overall cost saving associated with the intervention was € 72,769 per patient (from € 201,189 to € 128,420) and €139,717.65 for the whole group over 1 year. Conclusions A personalized follow-up of HF patients led to important outcome benefits and resulted in cost savings, mainly due to the reduction of patient hospitalization readmissions and a significant reduction of care-associated costs, suggesting that greater attention should be given to this high-risk cohort to minimize the risk of hospitalization readmissions.

scholarly journals Development of a Prognostic Model to Predict Mortality after Traumatic Brain Injury in Intensive Care Setting in a Developing Country

2021 ◽  
Vol 12 (02) ◽  
pp. 368-375
Author(s):  
Mini Jayan ◽  
Dhaval Shukla ◽  
Bhagavatula Indira Devi ◽  
Dhananjaya I. Bhat ◽  
Subhas K. Konar
Keyword(s):  
Traumatic Brain Injury ◽  
Intensive Care ◽  
Brain Injury ◽  
Hospital Mortality ◽  
Prognostic Model ◽  
Third Ventricle ◽  
The Third ◽  
Scan Data ◽  
Gcs Score ◽  
Basal Cisterns

Abstract Objectives We aimed to develop a prognostic model for the prediction of in-hospital mortality in patients with traumatic brain injury (TBI) admitted to the neurosurgery intensive care unit (ICU) of our institute. Materials and Methods The clinical and computed tomography scan data of consecutive patients admitted after a diagnosis TBI in ICU were reviewed. Construction of the model was done by using all the variables of Corticosteroid Randomization after Significant Head Injury and International Mission on Prognosis and Analysis of Clinical Trials in TBI models. The endpoint was in-hospital mortality. Results A total of 243 patients with TBI were admitted to ICU during the study period. The in-hospital mortality was 15.3%. On multivariate analysis, the Glasgow coma scale (GCS) at admission, hypoxia, hypotension, and obliteration of the third ventricle/basal cisterns were significantly associated with mortality. Patients with hypoxia had eight times, with hypotensions 22 times, and with obliteration of the third ventricle/basal cisterns three times more chance of death. The TBI score was developed as a sum of individual points assigned as follows: GCS score 3 to 4 (+2 points), 5 to 12 (+1), hypoxia (+1), hypotension (+1), and obliteration third ventricle/basal cistern (+1). The mortality was 0% for a score of “0” and 85% for a score of “4.” Conclusion The outcome of patients treated in ICU was based on common admission variables. A simple clinical grading score allows risk stratification of patients with TBI admitted in ICU.

scholarly journals Predicting hospital admissions from individual patient data (IPD): an applied example to explore key elements driving external validity

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e045572
Author(s):  
Andreas Daniel Meid ◽  
Ana Isabel Gonzalez-Gonzalez ◽  
Truc Sophia Dinh ◽  
Jeanet Blom ◽  
Marjan van den Akker ◽  
...  
Keyword(s):  
Prognostic Model ◽  
Prediction Models ◽  
Hospital Admissions ◽  
Absolute Risk ◽  
External Validation ◽  
Baseline Risk ◽  
Study Heterogeneity ◽  
Related Quality ◽  
Individual Participant ◽  
Risk Predictor

ObjectiveTo explore factors that potentially impact external validation performance while developing and validating a prognostic model for hospital admissions (HAs) in complex older general practice patients.Study design and settingUsing individual participant data from four cluster-randomised trials conducted in the Netherlands and Germany, we used logistic regression to develop a prognostic model to predict all-cause HAs within a 6-month follow-up period. A stratified intercept was used to account for heterogeneity in baseline risk between the studies. The model was validated both internally and by using internal-external cross-validation (IECV).ResultsPrior HAs, physical components of the health-related quality of life comorbidity index, and medication-related variables were used in the final model. While achieving moderate discriminatory performance, internal bootstrap validation revealed a pronounced risk of overfitting. The results of the IECV, in which calibration was highly variable even after accounting for between-study heterogeneity, agreed with this finding. Heterogeneity was equally reflected in differing baseline risk, predictor effects and absolute risk predictions.ConclusionsPredictor effect heterogeneity and differing baseline risk can explain the limited external performance of HA prediction models. With such drivers known, model adjustments in external validation settings (eg, intercept recalibration, complete updating) can be applied more purposefully.Trial registration numberPROSPERO id: CRD42018088129.

scholarly journals Injuries, treatment, and impairment caused by different types of fireworks; results of a 10 year multicenter retrospective cohort study

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Daan T. Van Yperen ◽  
Esther M. M. Van Lieshout ◽  
J. Niels Dijkshoorn ◽  
Cornelis H. Van der Vlies ◽  
Michael H. J. Verhofstad
Keyword(s):  
Surgical Procedures ◽  
Hospital Admissions ◽  
Case Series ◽  
Secondary Outcome ◽  
Number Of Patients ◽  
Whole Person ◽  
Type Of Injury ◽  
Clear Increase ◽  
Level 1 Trauma Center ◽  
Head Neck

Abstract Objectives The primary aim of this study was to evaluate the number of patients reported to a hospital with injuries from consumer fireworks in the months December–January in the past 10 years, and to describe the association between the type of fireworks, injury pattern, treatment, and permanent impairment. Methods A multicenter, retrospective, observational case series. Patients were selected from two hospitals in the Southwest Netherlands: a level 1 trauma center and a specialized burn center. All patients with any fireworks-related injuries treated between December 1 and January 31, during 2007 (December) to 2017 (January), were eligible for participation. The primary outcome was the number of patients with any type of injury caused by fireworks. The secondary outcome measures were patient and injury characteristics, treatment details, and whole person impairment (WPI). The percentage WPI expresses a patient’s degree of permanent impairments as a result of fireworks-related injuries. Results Of the 297 eligible patients, 272 patients were included. From 2007 to 2017, between 21 and 40 patients were treated, and no clear increase or decrease was observed in the number of patients and in the number of patients per type of fireworks. Explosive fireworks mainly caused upper extremity (N = 65; 68%) injuries, while rockets (N = 24; 41%) and aerials (N = 7; 41%) mainly affected the head/neck. Decorative fireworks predominantly resulted in burns (N = 82; 68%), and explosive fireworks in soft tissue lacerations (N = 24; 25%), fractures (N = 16; 17%), and amputations (N = 14; 15%). Patients injured by explosive and homemade fireworks were most often admitted to a hospital (respectively N = 24; 36% and N = 12; 80%), and resulted in the highest proportion undergoing surgical procedures (respectively N = 22; 33% and N = 7; 47%). WPI found in this study was between 0 to 95%, with a median of 0%. In 34 (14%) patients, the injuries resulted in a WPI of ≥1%, mostly as a result of explosive fireworks (N = 18; 53%). Conclusion This study found no increase or decrease in the number of patients treated in two specialized hospitals. Explosive and homemade fireworks could be considered as most dangerous, as they result into the most hospital admissions, surgical procedures, and into the most injuries with permanent impairment as a result.

scholarly journals Crohn’s disease: a population-based study of surgery in the age of biological therapy

2021 ◽  
Author(s):  
Christian Stöss ◽  
Maximilian Berlet ◽  
Stefan Reischl ◽  
Ulrich Nitsche ◽  
Marie-Christin Weber ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Minimally Invasive ◽  
Biological Therapy ◽  
Hospital Admissions ◽  
Diagnosis Related Groups ◽  
Age Distribution ◽  
Considerable Proportion ◽  
Discharge Data ◽  
Number Of Patients

Abstract Purpose Despite primary conservative therapy for Crohn’s disease, a considerable proportion of patients ultimately needs to undergo surgery. Presumably, due to the increased use of biologics, the number of surgeries might have decreased. This study aimed to delineate current case numbers and trends in surgery in the era of biological therapy for Crohn’s disease. Methods Nationwide standardized hospital discharge data (diagnosis-related groups statistics) from 2010 to 2017 were used. All patients who were admitted as inpatient Crohn’s disease cases in Germany were included. Time-related development of admission numbers, rate of surgery, morbidity, and mortality of inpatient Crohn’s disease cases were analyzed. Results A total number of 201,165 Crohn’s disease cases were included. Within the analyzed time period, the total number of hospital admissions increased by 10.6% (n = 23,301 vs. 26,069). While gender and age distribution remained comparable, patients with comorbidities such as stenosis formation (2010: 10.1%, 2017: 13.4%) or malnutrition (2010: 0.8%, 2017: 3.2%) were increasingly admitted. The total number of all analyzed operations for Crohn’s disease increased by 7.5% (2010: n = 1567; 2017: n = 1694). On average, 6.8 ± 0.2% of all inpatient patients received ileocolonic resections. Procedures have increasingly been performed minimally invasive (2010: n = 353; 2017: n = 687). The number of postoperative complications remained low. Conclusion Despite the development of novel immunotherapeutics, the number of patients requiring surgery for Crohn’s disease remains stable. Interestingly, patients have been increasingly hospitalized with stenosis and malnutrition. The trend towards more minimally invasive operations has not relevantly changed the rate of overall complications.

scholarly journals Recent Trends in Youth Concussions: A Brief Report

2020 ◽  
Vol 11 ◽  
pp. 215013272098505
Author(s):  
Andrew T. Askow ◽  
Jacob L. Erickson ◽  
Andrew R. Jagim
Keyword(s):  
Incidence Rate ◽  
Brain Injuries ◽  
Population Based ◽  
Health Records ◽  
Medical Issues ◽  
Number Of Patients ◽  
Recent Trends ◽  
Males And Females ◽  
Large Health Care System

Objectives Concussions and mild traumatic brain injuries are important medical issues, particularly among youth as the long-term health consequences of these injuries can become increasingly problematic. The purpose of this study was to examine recent trends in diagnosed concussions among pediatric patients in a large health care system. Methods This was a retrospective, population-based epidemiology study design that queried all patient files (pediatrics included) using electronic medical health records and further stratified patients based on type of concussion, age, sex, and year from 2013 to 2018. Results Electronic health records from a cohort of 8 832 419 (nmales = 4 246 492; nfemales = 4 585 931) patient visits were assessed for concussion diagnosis and filtered for those whose concussive event led to a loss of consciousness (LOC) or not (nLOC). Of these patients, 12 068 were diagnosed with a concussion (LOC = 3 699; nLOC = 8 369) with an overall incidence rate of 1.37 concussions per 1000 patients. Overall, the number of patients diagnosed with a concussion increased by 5063 (LOC = 1351; nLOC = 3712) from 2013 to 2018. Males and females presented with similar rates of concussions 5919 (49.05%) and 6149 concussions (50.95%), respectively. Of total diagnosed concussions, 4972 (LOC = 815; nLOC = 4157) were under the age of 18 and represented 41.2% of all diagnosed concussions with an incidence rate of 6.79 per 1000 patients. Conclusion The number of concussions diagnosed appear to be on the rise with the largest number of concussions being diagnosed in those under the age of 18. Future studies should seek to determine primary causality and the long-term health implications of concussions with or without LOC.

scholarly journals Multiple Brain Abscesses by an Air Gun Shot: A Case Report

2021 ◽  
Author(s):  
Mohammad Jamali ◽  
Iman Ahrari ◽  
Keyvan Eghbal ◽  
Arash Saffarrian ◽  
Abbas Rakhsha ◽  
...  
Keyword(s):  
Brain Injury ◽  
Brain Injuries ◽  
Good Condition ◽  
Signs And Symptoms ◽  
Low Velocity ◽  
Penetrating Brain Injury ◽  
Air Gun ◽  
Gun Shot ◽  
Brain Abscesses ◽  
Air Gun Pellet

Abstract Introduction Low-velocity penetrating brain injury is not prevalent. In some conditions such as childhood, and with the penetration of a pellet in weak spots of skull, low-velocity penetrating brain injury is expected; however, high-velocity projectiles have also been reported as the cause of severe brain injuries. One of the complications of penetrating brain injury is infection, in which different types of microorganisms play a role. The Streptococcus genus is the leading cause of abscess formation in non-traumatic patients. Multiple brain abscesses are not common. Case Presentation A 10-year-old boy with penetrating brain injury caused by an air gun pellet, who developed signs and symptoms of high intracranial pressure 18 days after the trauma. After the imaging scans and the detection of multiple brain abscesses and severe brain edema, prompt surgical intervention was performed for all three lesions in a single operation. The culture of a pus specimen was positive for Streptococcus species, and, with adequate antibiotic therapy, the patient was discharged from the hospital in good condition. Conclusion Brain injury with air gun shot is not prevalent. The penetration of a low-velocity air gun pellet in weak points of the skull (such as the orbit, the squamous portion of the temporal bone, and the cranial suture), specially in children, can cause significant brain injuries.

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